Current Science Research Bulletin

Metabolic dysfunction–associated steatotic liver disease (MASLD) and dyslipidemia are interconnected metabolic conditions associated with insulin resistance, adipose tissue dysfunction, oxidative stress, and chronic low-grade inflammation. Micronutrients have attracted attention because of their physiological roles in antioxidant defenses, one-carbon metabolism, mitochondrial function, and immune regulation. This narrative review examines the mechanistic rationale and clinical evidence for vitamin E, vitamin D, vitamins B6/B9/B12, zinc, selenium, and the related nutrients choline and omega-3 fatty acids. The PIVENS trial identified histological benefits of vitamin E in selected adults with non-diabetic steatohepatitis, whereas evidence for routine supplementation with other micronutrients remains insufficient. Omega-3 fatty acids can lower triglycerides but should not be regarded as proven antifibrotic therapy. Major challenges include heterogeneous trial populations, surrogate endpoints, baseline nutritional status, dose-related toxicity, and limited long-term outcome data. Future studies should integrate nutritional phenotyping, validated liver outcomes, and randomized trials to establish whether targeted correction of deficiency improves clinical outcomes beyond established lifestyle and cardiometabolic interventions.

micronutrients; MASLD; MASH; dyslipidemia; vitamin E; vitamin D; oxidative stress; personalized nutrition.

1. Angulo, P., et al. (2015). Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology, 149(2), 389–397.e10. https://doi.org/10.1053/j.gastro.2015.04.043
2. Armstrong, M. J., et al. (2016). Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): A multicentre, double-blind, randomised, placebo-controlled phase 2 study. The Lancet, 387(10019), 679–690. https://doi.org/10.1016/S0140-6736(15)00803-X
3. Browning, J. D., et al. (2004). Prevalence of hepatic steatosis in an urban population in the United States: Impact of ethnicity. Hepatology, 40(6), 1387–1395. https://doi.org/10.1002/hep.20466
4. Chalasani, N., et al. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67(1), 328–357. https://doi.org/10.1002/hep.29367
5. Cusi, K., et al. (2016). Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: A randomized trial. Annals of Internal Medicine, 165(5), 305–315. https://doi.org/10.7326/M15-1774
6. Day, C. P., & James, O. F. W. (1998). Steatohepatitis: A tale of two “hits”? Gastroenterology, 114(4), 842–845. https://doi.org/10.1016/S0016-5085(98)70599-2
7. Dongiovanni, P., et al. (2018). Nutritional therapy for nonalcoholic fatty liver disease. Journal of Nutritional Biochemistry, 29, 1–11. https://doi.org/10.1016/j.jnutbio.2015.08.024
8. European Association for the Study of the Liver, European Association for the Study of Diabetes, & European Association for the Study of Obesity. (2024). EASL–EASD–EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of Hepatology, 81(3), 492–542. https://doi.org/10.1016/j.jhep.2024.04.031
9. Friedman, S. L., Neuschwander-Tetri, B. A., Rinella, M., & Sanyal, A. J. (2018). Mechanisms of NAFLD development and therapeutic strategies. Nature Medicine, 24, 908–922. https://doi.org/10.1038/s41591-018-0104-9
10. Harrison, S. A., et al. (2024). A phase 3, randomized, controlled trial of resmetirom in NASH with liver fibrosis. The New England Journal of Medicine, 390, 497–509. https://doi.org/10.1056/NEJMoa2309000
11. Kim, S. J., Cho, S. H., & Yun, J. M. (2025). Omega-3 polyunsaturated fatty acids and nonalcoholic fatty liver disease in adults: A meta-analysis of randomized controlled trials. Clinical Nutrition, 50, 164–174. https://doi.org/10.1016/j.clnu.2025.05.013
12. Kleiner, D. E., et al. (2005). Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology, 41(6), 1313–1321. https://doi.org/10.1002/hep.20701
13. Loomba, R., & Sanyal, A. J. (2013). The global NAFLD epidemic. Nature Reviews Gastroenterology & Hepatology, 10, 686–690. https://doi.org/10.1038/nrgastro.2013.171
14. Manco, M., et al. (2010). Vitamin D levels in children with nonalcoholic fatty liver disease. Hepatology, 51(6), 2229–2230. https://doi.org/10.1002/hep.23722
15. Musso, G., Cassader, M., Rosina, F., & Gambino, R. (2014). Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis of randomised trials. Diabetologia, 55, 885–904. https://doi.org/10.1007/s00125-011-2446-4
16. Neuschwander-Tetri, B. A., et al. (2015). Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): A multicentre, randomised, placebo-controlled trial. The Lancet, 385(9972), 956–965. https://doi.org/10.1016/S0140-6736(14)61933-4
17. Petersen, K. F., et al. (2006). Reversal of nonalcoholic hepatic steatosis, hepatic insulin resistance, and hyperglycemia by moderate weight reduction in patients with type 2 diabetes. Diabetes, 54(3), 603–608. https://doi.org/10.2337/diabetes.54.3.603
18. Rinella, M. E., et al. (2023). AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology, 77(5), 1797–1835. https://doi.org/10.1097/HEP.0000000000000323
19. Rinella, M. E., et al. (2023). A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology, 78(6), 1966–1986. https://doi.org/10.1097/HEP.0000000000000520
20. Romeo, S., et al. (2008). Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nature Genetics, 40, 1461–1465. https://doi.org/10.1038/ng.257
21. Sanyal, A. J., et al. (2010). Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. The New England Journal of Medicine, 362(18), 1675–1685. https://doi.org/10.1056/NEJMoa0907929
22. Targher, G., Day, C. P., & Bonora, E. (2010). Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. The New England Journal of Medicine, 363(14), 1341–1350. https://doi.org/10.1056/NEJMra0912063
23. Tilg, H., & Moschen, A. R. (2010). Evolution of inflammation in nonalcoholic fatty liver disease: The multiple parallel hits hypothesis. Hepatology, 52(5), 1836–1846. https://doi.org/10.1002/hep.24001
24. Vilar-Gomez, E., et al. (2015). Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology, 149(2), 367–378.e5. https://doi.org/10.1053/j.gastro.2015.04.005
25. Yan, J.-H., Guan, B.-J., Gao, H.-Y., & Peng, X.-E. (2018). Omega-3 polyunsaturated fatty acid supplementation and non-alcoholic fatty liver disease: A meta-analysis of randomized controlled trials. Medicine, 97(37), e12271. https://doi.org/10.1097/MD.0000000000012271